Humoral Hypercalcemia of Malignancy in a Patient with Large Cell Carcinoma of the Lung: Report of Case and Review of Literature |
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| Institution: | 1. Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, USA;2. Lowe Center for Thoracic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA;3. Division of Hematology Oncology, Department of Medicine, Columbia University, New York, USA;4. Department of Informatics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA;5. Department of Pathology, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, USA;6. Department of Epidemiology and Biostatistics, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, USA;7. Department of Radiology, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, USA;8. Department of Early Drug Development Service, Division of Solid Tumor Oncology, Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, USA;9. Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA;10. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA;11. Department of Radiology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA |
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| Abstract: | ObjectiveTo report a case of hypercalcemia associated with parathyroid hormone-related protein (PTHrP) in large cell carcinoma of the lung.MethodsWe present a case of PTHrP-mediated hypercalcemia in a patient with a large cell carcinoma of the lung and review the related literature.ResultsA 43-year-old African American man required medical attention because of lethargy, confusion, and poor oral intake. He had bullous emphysema attributable to a 50-pack-year smoking history. On physical examination, vital signs were normal, he was oriented to place and person but not time, and he had cachexia. Breath sounds were decreased in the left lower lung field. Findings on cardiac and abdominal examination were normal. Results of laboratory studies (and corresponding reference ranges) were as follows: calcium 12.1 mg/dL (8.5 to 10.5), albumin 2.0 g/dL (3.5 to 5.0), phosphorus 2 mg/dL (2.5 to 4.5), alkaline phosphatase 68 U/L (40 to 150), intact parathyroid hormone 5 pg/mL (10 to 60), PTHrP 7.0 pmol/L (0.0 to 1.5), 1,25-dihydroxyvitamin D 20.8 pg/mL (25.1 to 66.1), and 25-hydroxyvitamin D 3.7 ng/mL (10 to 60). Computed tomographic scans of the chest showed a large complex lesion in the left lower hemithorax, a small right pleural effusion, and extensive pulmonary emphysema bilaterally. Open lung biopsy revealed a large cell undifferentiated carcinoma. Abdominal and pelvic computed tomographic scans showed no evidence of metastatic involvement. A bone scan was negative for osseous metastatic lesions.ConclusionAlthough the finding is rare, patients with large cell carcinoma of the lung and hypercalcemia may have humoral hypercalcemia mediated by PTHrP. (Endocr Pract. 2007;13:389-395) |
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